Truth or Dare: How to Commit Professional Suicide

In the March issue of Obstetrics and Gynecology, a premiere journal in my field, I read a report on publication puffery -- “Unverifiable and Erroneous Publications Reported by Obstetrics and Gynecology Residency Applicants” by Simmons et al.The abstract summarizes the findings:

In the March issue of Obstetrics and Gynecology, a premiere journal in my field, I read a report on publication puffery — “Unverifiable and Erroneous Publications Reported by Obstetrics and Gynecology Residency Applicants” by Simmons et al.The abstract summarizes the findings:

546 out of 937 residency applicants listed themselves as authors or co authors in a grand total of 2,251 publications including articles or abstracts, with 37% supposedly in peer reviewed journals. Journals were sifted and 85% were found, but 15% could not be verified. In the listing of peer-reviewed articles or abstracts, 25.5% (90 of 353) major errors were found, minor errors in 12.5% (44 of 353) and 24.1% (85 of 353) remained unverified. These were supposedly in peer reviewed journals, not some obscure internet or foreign publication.

The authors concluded that “… a concerning number of applicants had major errors in their citations or reported articles that could not be found, despite extensive searching. Reported major and unverified publication errors are common and should cause concern for our specialty, medical schools, and our entire medical profession.” Lee Learman, MD MPH, in the accompanying editorial labeled puffed up publications “Bibliografaking.” Perfect!

Shortly after reading this study, I also read an article in the NY Times on April 18, 2012 commenting on the increasing number of retractions of scientific papers in recent years. The Times discussed the experience of Dr. Ferric C. Fang, editor in chief of the Journal “Infection and Immunity.” Dr. Fang in auditing articles found that one of his colleagues had doctored several papers. The journal was forced to issue retractions for all 6, having only issued 9 retractions in the preceding 40 years. Dr. David Korn of Harvard Medical School was quoted as saying that “there are problems all through the system.”

The accompanying graphic vividly displayed data from the Journal of Medical Ethics, and the magnitude of the problem is startling. While the most common reason for withdrawing a paper is error, found in 73.5% of retractions with many involving scientific mistakes, other reasons are more disquieting. Fabrication, fraud, data plagiarism, and text plagiarism are not uncommon nowadays.

One of the most notorious cases centers on the retraction of a British study linking autism to childhood vaccines. The work done by the now-notorious Dr. Andrew Wakefield has been called an “elaborate fraud” wherein the lead author altered the histories of 12 patients. His co-authors were unaware of the data manipulation and signed on to this 1998 study linking vaccination and autism. The British Medical Journal stated that this malfeasance has caused irreparable damage to the public health. Last year, Dr. Wakefield had his medical license revoked last year, but many parents continue avoiding childhood vaccination for their own kids, thus putting putting all children at risk.

Dishonesty, carelessness and fraud in medicine and the life sciences is especially egregious. Mistakes and misrepresentation in our research studies puts human life at risk. Lying and fraud should be obvious threats, but serious harm may accrue from a tiny twisted truth or from lightly tortured data.

I cannot claim that, like Claude Rains as Captain Louis Renault in the “Casablanca,” “I am shocked, truly shocked.“ Actually, I am not shocked at all. Why not? Because when I went to medical school, I worked undercover investigating crooked doctors. Over the course of two years, I bought drugs for the State of California. And I was blown away by the behavior of these criminals (many were arrested and charged) who were supposed to be healers. Why would anyone with all that training, all that potential for success, all that economic power, stoop to selling drugs? No profession, it seems, even one as highly esteemed as medicine, is free from greed and deceit.